Slide 1 Sharing Images without CDs, The Next Imaging Sea Change GE Healthcare Chris Lindop GE Healthcare Interoperability & Standards.

Slide 1

Sharing Images without CDs,

The Next Imaging Sea Change

GE Healthcare

Chris Lindop GE Healthcare

Interoperability &

Standards

In the Beginning:

Film

Film – the First Standard for Image ExchangeIn the beginning….• open image exchange started with one reliable

method: FILM

Advantage:• Everyone can view the Film

Issue: to be solved:• Inconsistent visual quality• Annotations, notes, etc. were attached “stuck-on”

IHE Solution:• Consistent Presentation of Images (CPI) Integration

Profile– Grayscale Standard Display Function (consistent

images)– Grayscale Softcopy Presentation State

(Annotations)

Radiology Enters the Digital Image Exchange:

Portable Media: CDs

Portable Media– the next interop challengeCDs or coasters?• Then came the introduction of CDs and other portable

media, but for most, was simply coasters for your morning coffee.

Issues to be solve:• Media in-compatibility• Inconsistent viewer capabilities • No import method to reviewer’s view station

IHE Solution:• Portable Data for Imaging (PDI) – Standard media

format• Basic Image Review (BIR) – Basic Viewer capability

requirements• Import Reconciliation Workflow (IRWF) – Standard

import method

Electronic Images Sharing beyond your

Institution

The Image Exchange

Slide 7 7

Use of a shared XDS Community-based infrastructure to access Radiology Reports and Images (XDS-I)

Hospital

Imaging CenterPhysician Practice

Between Radiology and :• Imaging specialists• Non-imaging clinicians• Patients

PACS Y

PACS Z

Radiology -to-

RadiologyRadiology –to –

Physicians

Specifies how Radiology Information Objects, Both DICOM Instances and non-DICOM Reports are distributed in an eHealth Community 7

XDS Affinity Domain Considerations

• Set of organizations/systems organized around a single Registry

• Common set of Codes

• Single Patient ID Domain

• Involves business and legal agreements

• Security model/agreements

IHE Integration Profiles for Health Info Nets What is available and in trial implementation

Emergency Referrals Format of the Document Content

and associated coded vocabulary PHR Extracts/Updates

Format of the Document Content and associated coded vocabulary

ObGyn Documents


Lab Results Document Content


Scanned Documents Format of the Document ContentImaging Information


Medical Summary (Meds, Allergies, Pbs)

Format of the Document Contentand associated coded vocabulary

Clinical and PHR Content

Health Data Exchange

Patient Demographics Query

Patient Identifier Cross-referencing

Map patient identifiers across independent identification

domains

Document Subscription and

Notification

Request Formfor Data Capture

External form with custom import/export scripting

Patient ID Mgmt

Other

Final Text Approved Trial Implementation

Cross-Enterprise Document Sharing

Registration, distribution and access across health enterprises of clinical

documents forming a longitudinal record

Cross-Enterprise Document Pt-Pt Reliable InterchangeCross-Enterprise Document

Media InterchangeCross-Community Access

Security & Privacy

Consistent TimeCoordinate time across networked

systems

Audit Trail & Node Authentication

Centralized privacy audit trail and node to node authentication to create

a secured domain.

Basic Patients Privacy Consents

Establish Consents & Enable Access Control

Document Digital Signature

Attesting “true-copy and origin

Cross-Enterprise User Assertion

Provides Trusted Identity

10

Cross-Enterprise Document Sharing (XDS.b) Actor/Transaction Diagram

Document Consumer

Retrieve Document Set

Query Documents

Patient Identity Source

Patient Identity Feed

Document Source

Document Registry

Document Repository

Provide&Register Document Set

Register Document Set

Slide 11

XDS-I.b Actors and Transactions

Imaging

Document Source

Document Consumer (XDS.b)

Document Registry (XDS.b)

Document Repository (XDS.b)

Provide & Register Imaging Document Set – MTOM/XOP

Register Document Set – b


Registry Stored Query

WADO Retrieve RAD-69 Retrieve Imaging Document Set

Retrieve Images Retrieve Presentation States Retrieve Reports Retrieve Key Image Note Retrieve Evidence Documents

Imaging Document Consumer

Pateint Identity Source

Pateint Idenity Feed

Same XDS Infrastructure (Registry and Repositories) for medical summaries and imaging

information !

Linking Report to Prior Images and Prior Report

Document Repository

Document Registry

DocumentEntry

SubmissionSet 3

Prior Study

Manifest

DocumentEntry

SubmissionSet 1

Prior Report

DocumentEntry

SubmissionSet 2

Report

DocumentEntry

SubmissionSet 4

Study

Manifest

13

Shared StorageServices

Enterprise

Enterprise

Enterprise

Imaging Center

Hospital B

Hospital A

Emergency Room

GP 1

PatientAdmin

Repository

RepositoryRepository

Cross-Enterprise Document Registry(XDS)

Cross-Enterprise Document Registry(XDS)

Cross-Enterprise Document Sharing

Practice

Data Centre

GP 2

Practice

Electronic Images Sharing beyond …..

Cross-Community Image Exchange

Cross-Community Access of Images (XCA-I) the next Sea change

Foundational with Standards incl. DICOM Web services– DICOM WADO-WS supp-148)

Interoperable with clinical portals– Compatible with IHE Web services profiles, including Security

and privacy

Interoperable with PACs and vendor neutral archives– Ready for cloud hosted apps

16

Why extend XDS?

XDS only addresses document sharing within an XDS Affinity Domain

Cross-Community addresses the questions: How to share documents between XDS Affinity

Domains? How to share documents with non-XDS Affinity

Domains?

17

Responding Community Initiating Community

Initiating Gateway

Responding Gateway

Cross Gateway Query [ITI-38]

Cross Gateway Retrieve [ITI-39]

XCA Transaction Diagramminimum required

18


Initiating Gateway

Registry Stored Query [ITI-18]

Retrieve Document Set [ITI-43]



Responding Gateway

Document Registry

Document Repository





XDS Document Consumer

Document Consumer

Document Consumer

Document Repository Document Registry

XCA Transaction Diagram

5

10

15





[ITI-43]



XCA Responding

Gateway

Imaging Document Source

Retrieve Imaging Document Set [RAD-69]

XDS.b Document Repository

XDS.b Document Registry



Responding Imaging Gateway


[ITI-43]

XDS.b Document Registry

XDS.b Document Repository

XCA Initiating Gateway

Initiating Imaging Gateway

XDS.b Document Consumer

Imaging Document Consumer

Retrieve Imaging Document Set[RAD-69]


Cross Gateway Retrieve Imaging Document Set

[RAD-75]

XCA-I Transaction Diagram

XCA-I

Foundational with Standards incl. DICOM Webservices– DICOM WADO-WS supp-148)

Interoperable with clinical portals– Compatible with XDS.b, XUA, ATNA

Interoperable with PACs and vendor neutral archives– Compatible with XDS-I.b, DICOM-WS– Ready for cloud hosted apps

Imaging Object Change Management (IOCM)

IOCM specifies how to communicate changes applied on existing imaging objects to other systems. Changes include

(1) rejection due to quality or patient safety reasons,

(2) correction of incorrect modality worklist entry selection,

(3) expiration due to data retention requirements.

IOCM is fully compatible with existing profiles!

22

Providers and VendorsWorking Together to Deliver

Interoperable Health Information Systemsin the Enterprise

and Across Care Settings

http://www.ihe.net

http://www.ihe.net.au

http://www.ihe.net/

http://www.ihe.net.au/

Slide 1 Sharing Images without CDs, The Next Imaging Sea Change GE Healthcare Chris Lindop GE Healthcare Interoperability & Standards.

Documents

film slide

radiology radiology

image exchange slide

portable media

coded vocabulary clinical

pbs format

radiology reports

images xds